Program for Reducing Opioid Use in Women Undergoing C-Sections Proves Successful
With an eye toward reducing post-operative opioid consumption during inpatient stays by 30 percent, the Enhanced Recovery after Cesarean delivery (ERAC) was implemented two years ago by Abington Hospital – Jefferson Health.
What is ERAC?
ERAC is fashioned after the Enhanced Recovery after Surgery program (ERAS). The purpose of both enhanced recovery programs is to provide postoperative, patient-centered care pathways, which promote early activity, early nutrition, deep breathing exercises and multi-modal pain control. The ERAC program is a treatment program designed to achieve early recovery for patients who have gone through a Cesarean delivery (C-section). The program focuses on providing patients with:
- Education on pain expectations and management
- Long-acting spinal morphine during surgery
- A schedule of non-opioid pain medications after surgery
ERAC Measures of Success
Since the implementation of ERAC, Abington – Jefferson Health physicians have cared for more than 2,300 mothers delivering by C-section. Those mothers maintained a 63 percent decrease in opioid consumption throughout their inpatient care, exceeding the initial goal. Approximately 25 percent of the 2,300 mothers were discharged without requiring any postoperative opioid pain medications.
Along with the decrease in opioid use, reviews of patient-reported pain scores noted improvements in pain management. The scores show an average decrease in patient-reported pain for each postoperative day. A successful reduction in opioid exposure may result in a long-term impact for families by decreasing the risk for chronic opioid use disorders and neonatal abstinence syndrome.
2020 HAP Award Recipient
These accomplishments have not gone unnoticed. Recently, Abington – Jefferson Health’s program entitled ‘Enhanced Recovery for Cesarean Deliver: A QI Project to Reduce Opioid Use’ was the recipient of a 2020 Achievement Award from the Hospital and Healthsystem Association of Pennsylvania (HAP). The program was among the few selected of over 100 entries for the Excellence in Care award.
Susan (Sue) Utterback, DNP, MSIT, RN, nursing systems coordinator, Women and Children’s Services and Kathryn (Katie) Ruymann, MD, resident, OB/GYN, worked together on this project.
“During this project, Katie and I were guided by a quote from Atul Gawande, MD, MPH: ‘Better is possible. It does not take genius. It takes diligence. It takes moral clarity. It takes ingenuity. And above all, it takes a willingness to try,’” Utterback expresses. “Hundreds of professionals, across multiple disciplines, showed ‘a willingness to try’ to improve care for the families giving birth at Abington, and have sustained this improvement for close to two years. It is a testament to their commitment to the well-being of our community, and I am proud to be a part of the Women and Children’s Services team.”
With additional guidance from Stephen J. Smith, MD, associate director, OB/GYN Residency Program and assistance from Tara Rakeiwicz, a medical student at the time, in data collection, the pair conducted literature searches and appraisals of the evidence to present to the team, developed the clinical pathway, educated and provided feedback to staff and providers, and conducted close to 700 historical and post-intervention chart reviews.
“Sue and I first connected on this project together in 2018, when I was half-way through my first year of residency. To receive a HAP award for the ERAC program is astounding and very exciting,” Ruymann emphasizes. “Now, seeing the full circle of the project and hearing colleagues announce that patients are on the ERAC program is just wow. I think it goes to show that you can make a change to something that has been the same for so long, just by thinking outside the box.”
This fall, Utterback and Ruymann will be presenting together on the ERAC program at the virtual HAP Conference and the Associate of Women’s Health, Obstetric and Neonatal Nurses virtual conference.
This project has inspired Abington – Jefferson Health to pursue other initiatives in Bariatric, Colorectal and Vascular surgeries to help prevent dependence on opioid pain relievers and to raise awareness and destigmatize substance use disorder.